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Confusing drug instructions are part of the problem, a report says.

Consider it the other drug problem: Millions of people don't take their medicine correctly - or quit taking it altogether - and the consequences can be deadly.

On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued this week by the nonprofit National Council on Patient Information and Education. The report calls the problem a national crisis costing billions of dollars.

The government is preparing steps to try to persuade patients and their doctors to do better.

But with contributors that range from too-hurried doctor visits to confusing pill bottles, there's no easy solution.

"We go into this with some humility," said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in your face" campaign to improve medication adherence. "It's really pretty appalling how badly we do."

This goes far beyond the issue of affording prescriptions. Often people buy their drugs but misunderstand what they're supposed to take, or how. Or forget doses. Or start feeling better and toss the rest of the bottle. Or skip doses for fear of side effects.

It's not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is former President Bill Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.

Why is taking medicines correctly so tough? One reason is the general confusion surrounding drugs, said Dr. Ruth Parker of Emory University, a co-author of the new report who has studied the issue for the American College of Physicians Foundation.

When the pharmacy hands over your prescription, there are bunches of papers - stapled to the bag, outside the box, glued to the bottle - that all bear drug information, but often with different wording.

Parker recently helped test the seemingly simple instruction "Take two tablets twice daily." Did that mean a total of two, or a total of four? A third of patients who were deemed literate got confused. A more clear instruction would be: "Take two tablets in the morning and two tablets at night."

Whatever the cause, Clancy hopes to make "take your medicine" a new priority. Her agency is starting discussions with the new report's authors, the Food and Drug Administration, and health groups about steps to do that. Options range from attention-grabbing ads about the dangers of misusing medicines to better drug labels.


Tips for patients

Some tips to help patients take their medicines correctly, from the nonprofit National Council on Patient Information and Education:

-Before leaving the doctor's office with a new prescription, ask detailed questions including: How and when do I take this? When do I quit?

- Bring to each doctor's appointment a complete list of all prescription and nonprescription medicines you take, so the doctor can check if a planned new drug will interact badly with an existing one.

-If you have problems understanding the instructions that come with the medicine, ask the pharmacist for help.

-Patients who forget doses could try setting up pill boxes at the beginning of each week with morning, noon and night doses in separate compartments.